Provider Demographics
NPI:1568043024
Name:HAYNES, CAITLIN
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:HAYNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 PLEASANT HILL GLIMP RD
Mailing Address - Street 2:
Mailing Address - City:HENNING
Mailing Address - State:TN
Mailing Address - Zip Code:38041-6448
Mailing Address - Country:US
Mailing Address - Phone:731-413-9660
Mailing Address - Fax:
Practice Address - Street 1:261 PLEASANT HILL GLIMP RD
Practice Address - Street 2:
Practice Address - City:HENNING
Practice Address - State:TN
Practice Address - Zip Code:38041-6448
Practice Address - Country:US
Practice Address - Phone:731-413-9660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN223961163W00000X
TN29806363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse